Original ArticleNeutrophil Gelatinase-Associated Lipocalin Concentrations Predict Development of Acute Kidney Injury in Neonates and Children after Cardiopulmonary Bypass
Section snippets
Methods
This study was approved by the institutional review board of Cincinnati Children’s Hospital Medical Center. All patients <18 years of age undergoing cardiac surgery with CPB at our center between January 2004 and May 2007 were approached for study inclusion. Written informed consent was obtained from the legal guardian of each patient, with assent from the patient when appropriate, before enrollment. Patients with severe pre-existing renal insufficiency (SCr concentration >2 times reference
Results
Overall, 374 children were enrolled. A total of 65% of eligible patients consented to participate in the study. Demographic and clinical characteristics of enrolled patients were similar to the overall cardiac surgery population at our institution. One patient was ineligible because of severe kidney injury, and no patients were excluded because of past nephrotoxin use. One patient was subsequently excluded from analysis because the date of birth was not available. Thirty-five patients were in
Discussion
Our results confirm that plasma and urine NGAL are excellent early predictors for AKI after neonatal and pediatric CPB. In both of the age groups, urine and plasma NGAL predicted AKI within 2 hours after onset of CPB, with very high sensitivity and specificity rates. Additionally, in the non-neonatal group, NGAL was associated with AKI severity and clinical prognosis. Thus, NGAL offers a unique opportunity to dramatically affect the management of AKI by delivering diagnostic, severity, and
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Supported by grants from the National Institutes of Health (RO1-HL08676, RO1-HL085757, RO1-DK069749) and a Translational Research Initiative Grant from Cincinnati Children’s Hospital Medical Center. P.D. is a co-inventor of patents related to neutrophil gelatinase-associated lipocalin as an acute kidney injury biomarker and is a consultant to Abbott Diagnostics and Biosite. The other authors declare no conflicts of interest.